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Question about ED after Brachytherapy

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Posted 9/26/2013 12:46 PM (GMT 0)
My younger brother who is 58, was just diagnosed with prostate cancer with a psa of 6.5 and gleason 6 with 5 of 12 samples positive.  He is leaning towards Brachytherapy rather than surgery like I had, but wanted me to ask here about the long term ED affects after seed implant. At 56, he is in excellent health and has no ED currently. 

 From reserach, we found that in the short term, there is no noticable ED from Brachytherapy, but after a few years,  about 50% of the men have some form of ED.   Has anyone here had Brachytherapy done more than 3 years ago, and if so, do you have any ED?

Posted 9/26/2013 1:15 PM (GMT 0)
Hi NY-Sooner. Actually we have several LDR brachytherapy folks on our forum who had their procedure over three years ago. Mine was five years ago and I have no ED. JustJulie's husband was around seven years ago and she continues to report no ED. JohnT's was around four years ago and he has no ED. Maybe they will chime in and there may be others whom I am overlooking this morning.

Of course, anecdotal stories for brachy are only a small part of the story just as they are for surgery. The broad story is that with surgery there is usually early ED that frequently gets better. With radiation there is usually no early ED and that sometimes gets worse. The most accepted stats that I have seen show about 50% of surgery patients have long term ED while about 35% of LDR brachytherapy patients have long term ED. Studies have shown that, for some reason, brachy patients respond better to the common pills.

One of the studies I used to help me in my decision was concerning quality of life in PCa patients and published in the New England Journal of Medicine. What jumped out at me was "Overall Sexual Problems" at the two year mark. It went from 12% to 43% for surgery patients and from 18% to 30% for an older contingent of brachytherapy patients.

These statistics are broad and naturally cannot be applied to any individual patient. And, the best practitioners for both surgery and brachytherapy claim much better results than these numbers. However, if ED is a major concern and you play the odds, the chances of ED are considerably lower with brachy.

Hope this helps.

Jim

P.S. HDR brachy seems to report an even lower percentage of ED than LDR and perhaps some of the HDR guys will post here also.
Posted 9/26/2013 1:15 PM (GMT 0)

NY-Sooner said...
My younger brother who is 58, was just diagnosed with prostate cancer with a psa of 6.5 and gleason 6 with 5 of 12 samples positive. He is leaning towards Brachytherapy rather than surgery like I had, but wanted me to ask here about the long term ED affects after seed implant. At 56, he is in excellent health and has no ED currently.


From reserach, we found that in the short term, there is no noticable ED from Brachytherapy, but after a few years, about 50% of the men have some form of ED. Has anyone here had Brachytherapy done more than 3 years ago, and if so, do you have any ED?

An interesting topic indeed and although I don't have my 3 years in yet, I can say so far so good. I would think that surgery would pose a bigger threat to ED than Brachy and then again there are many factors to consider before comparing the two(one being current developments in how the procedures are applied)
Posted 9/26/2013 1:33 PM (GMT 0)
Hi and welcome. I had my LDR BT only one year ago and have no issues with ED - not the time frame you're looking for I realize.

While doing my research during that part of my journey I gathered significant information on the various treatment modalities in terms of both chance of recurrence as well as SE's, and I'd be happy to share that with you and your brother. You can send an e-mail to me by clicking on the 'envelope' right below A Yooper in the top left of this post and I'll reply.

The biggest issue in all of this is the skill of the practitioner, particularly given that your brother has a good baseline of no ED now.

I'm sure others will weigh in soon - good luck and best to you both.
Posted 9/26/2013 1:45 PM (GMT 0)
Six months out and "harder than Chinese algebra" here.
Posted 9/26/2013 2:32 PM (GMT 0)
Hi NY-Sooner & Brother,

Well Jeff is 4 months 2 weeks short of his 3 year anniversary post Brachy. Not quite at the 3 year mark yet but we are very happy to report zero ED!

All the best to you both.

Susan
x
Posted 9/26/2013 4:05 PM (GMT 0)
Over 4 1/2 years and no ED. My RO said that the side effects you have at the 2 year mark are the ones you will be stuck with for life.
Posted 9/26/2013 6:03 PM (GMT 0)
ED was my greatest concern about the SEs of therapy. Here's what I found:

Potency preservation (among previously potent men) after 2+ years:
HDR Brachy (Wm Beaumont) - 82%
SBRT (Katz) - 75%
IGRT/IMRT no ADT (Memorial Sloan Kettering) - 65%
LDR Brachy/seeds (UW Seattle) - 56%
IGRT/IMRT with ADT (Memorial Sloan Kettering) - 46%
RP - nerve sparing -37%*
RP - no nerve sparing - 13%*
Protons (Mass General) - sexual dysfunction scores nearly doubled from 25 vs. 48

* there is a wide range of reported rates - this is the national average from the Sanda study. I'm certain that the results obtained by the best surgeons and at tertiary care centers are quite a bit better.

There is a range of ways this is measured, and it depends on the patient's subjective assessment. Also, there are many confounding variables like age, co-morbidities, use of ED meds, etc. so these studies are not strictly comparable. I think it just gives a rough idea.
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